Day programs for children and adolescents with eating disorders: A systematic review  

Why is this research important? 

Eating disorders are highly prevalent, complex and serious mental illnesses with a high rate of onset in adolescence [1-3]. When left untreated, eating disorders may persist long term and contribute to physical health complications and reduced quality of life and life expectancy [4]. For children and adolescents, eating disorders have a high risk of interfering with normal development and growth, highlighting the importance of prevention, early intervention and treatment of eating disorders for this group [5]. Due to their complexity and influence on both physical and mental health, treatment recommendations for eating disorders will differ for each person and vary as their individual needs change.  

Eating disorder treatment is delivered at a range of intensities, from community-based, community-based intensive and hospital-based treatment depending on a person’s unique needs. A variety of treatment options are emerging as an alternative to hospital-based treatment to meet the needs of people with eating disorders who require a higher level of care than community-based treatment but may not require or respond well to hospital treatment [6,7]. Day programs are one such alternative and encompass any program where the patient does not stay overnight at a treatment facility and receives increased treatment intensity relative to other community-based programs [6]. Typically, day programs provide 6-10 hours per day of treatment and supervised mealtimes 3.5-5 days per week [8].  

In their recent systematic review, Krishnamoorthy and colleagues describe and evaluate the efficacy of day programs for children and adolescents with eating disorders. Previous studies have examined the use of day programs for both adult and adolescent populations, however this is the first review to evaluate the effectiveness for children and adolescents. This is important to further understand appropriate interventions for this group. 

Common elements identified across all studies included the use of FBT-informed care (with some including additional CBT-E and DBT approaches) and the use of multidisciplinary teams. The authors identified wide variation in the types of additional interventions and activities. 

The authors concluded that based on the 21 studies included in their review, eating disorder day programs for children and adolescents benefit physical and psychological recovery [9]. Additionally, the review highlights the effectiveness of the use of evidence-based treatments such as FBT-informed care and CBT-E within the day programs for this group [9]. The included studies reported positive outcomes for children and adolescents who attended eating disorder day programs such as body weight restoration and symptom reduction [9]. However, the heterogeneity of the included studies, the day programs and the people accessing them make it difficult to draw concrete conclusions about what components are effective and for who. The authors call for additional and more robust research of eating disorder day programs for children and adolescents to further guide treatment for this group.  

Authors: Govind Krishnamoorthy, So Min Shin, Bronwyn Rees  

Abstract/Summary: 
Background: Day programs have received significant consideration within psychological literature as part of a continuum of mental health services. With increasing attention on the prevalence of eating disorders in children and adolescents, and the need for early intervention to minimize the costs and burden of the disorder, eating disorder day programs (also referred as partial hospitalization) have begun to emerge around the world. Despite their widespread use, no reviews to date have examined the efficacy of day programs for the treatment of eating disorders in children and adolescents. The current narrative literature review aims to describe and evaluate the efficacy of day programs for children and adolescents.  
Methods: The literature review was conducted according to the PRISMA guidelines and aimed to explore the outcomes and common program elements of day programs to guide clinical practice and service development.  
Results: The review found variations amongst the day programs related to program elements, measures utilized and outcomes.  
Conclusion: Overall, the results suggest that day programs for children and adolescents are effective at restoring body weight, reducing eating disorder symptoms and addressing comorbid mental health concerns. 

Access: Open 

Link: https://onlinelibrary.wiley.com/doi/10.1002/erv.2953  

Citation: Krishnamoorthy, G., Shin, S. M., & Rees, B. (2022). Day Programs for children and adolescents with eating disorders: A systematic review. European Eating Disorders Review, 1-27. https://doi.org/10.1002/erv.2953 

References:

1. Deloitte Access Economics. Paying the price: the economic and social impact of eating disorders in Australia [Internet]. Australia: Deloitte Access Economics; 2012 [cited 2022 Nov 11]. Available from: https://butterfly.org.au/wp-content/uploads/2020/06/Butterfly_Report_Paying-the-Price.pdf  

2. Lawrence D, Johnson S, Hafekost J, Boterhoven De Haan K, Sawyer M, Ainley J, Zubrick SR. The mental health of children and adolescents. Report on the second Australian child and adolescent survey of mental health and wellbeing [Internet]. Australia: Department of Health; 2015 [cited 2022 Nov 11]. Available from:  https://www.health.gov.au/sites/default/files/documents/2020/11/the-mental-health-of-children-and-adolescents_0.pdf  

3. National Eating Disorders Collaboration (NEDC). Eating disorders: key considerations for service providers [Internet]. NEDC; 2021 [cited 2022 Nov 11]. 6p. Available from: https://nedc.com.au/assets/NEDC-Publications/NEDC-Eating-disorders-key-considerations-for-service-providers.pdf   

4. National Eating Disorders Collaboration (NEDC). Consultation Papers [Internet]. NEDC; 2014 [cited 2022 Nov 11]. Available from: https://nedc.com.au/assets/NEDC-Consultation-Papers-compressed-2.pdf  

5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association; 2013. Available from:  https://doi.org/10.1176/appi.books9780890425   

6. Baudinet J, Simic M. Adolescent Eating Disorder Day Programme Treatment Models and Outcomes: A Systematic Scoping Review. Front Psychiatry [Internet]. 2021 [cited 2022 Nov 11];12. Available from: https://doi.org/10.3389/fpsyt.2021.652604 

7. Derenne J. The role of higher levels of care for eating disorders in youth. Child Adolesc Psychiatr Clin N Am [Internet]. 2019 [cited 2022 Nov 11];28(4):573-582. Available from: https://doi.org/10.1016/j.chc.2019.05.006   

8. Simic M, Stewart CS, Eisler I, Baudinet J, Hunt K, O’Brien J, McDermott B. Intensive treatment program (ITP): A case series service evaluation of the effectiveness of day patient treatment for adolescents with a restrictive eating disorder. Int J Eat Disord [Internet]. 2018 [cited 2022 Nov 11];51:1261-9. Available from: https://doi.org/10.1002/eat.22959 

9. Krishnamoorthy G, Shin SM, Rees B. Day Programs for children and adolescents with eating disorders: A systematic review. Eur Eat Disord Rev [Internet]. 2022 [cited 2022 Nov 11];1-27. Available from: https://doi.org/10.1002/erv.2953